Severely Impaired Fetal Growth is Preceded by Maternal Hemodynamic Maladaptation in Very Early Pregnancy

Objective: To test the hypothesis that in pregnancies complicated by intrauterine growth retardation (IUGR) maternal cardiovascular adaptation is already abnormal in the first weeks of pregnancy.

Setting: University Hospital Maastricht, Maastricht, The Netherlands.

Subjects: Fourteen healthy pregnant women, recruited from the subfertility clinic. Ten pregnancies were uneventful and four pregnancies resulted in the birth of growth retarded infants.

Methods: Maternal cardiovascular status was followed longitudinally by combined M-mode and Doppler echocardiography. Studies were performed weekly between the fifth and 10th week, at 14, 25 and 35 weeks and postpartum. Differences between the two groups were analyzed by nonparametric tests.

Results: In early pregnancy, the IUGR group differed from the normal group by a consistently smaller left atrial diameter and a cardiac output that failed to increase. Postpartum the subjects in the IUGR group had a significantly smaller left atrial diameter and faster mean circumferential fiber shortening.

Conclusion: Maternal hemodynamic adaptation in the first weeks of pregnancy is defective in IUGR pregnancies, presumably associated with a concomitant inadequacy of the vascular filling state.